The need for documented proof establishing a direct nexus between the accident/injury and the death of the insured employee in insurance claim cases.

JUDGMENT :

Heard learned counsel for the parties through V.C.

2. The instant writ application was initially preferred by the widow of the deceased employee who died while in service praying therein for a direction upon the respondent authorities, especially Respondent No.5 to pay the Group Personal Accident Insurance Claim of Rs.5,00,000/-to the petitioner.

During pendency of this writ application the widow-Parwati Devi died and other legal heirs were substituted pursuant to order of this court.

3. Brief facts relevant for disposal of the instant writ application are that the husband of the original-petitioner, namely Nageshwar Mahto was employed under Respondent Coal Company and he was insured with Respondent No. 5 under Group Personal Accident Insurance Scheme as the employer C.C.L. entered into an agreement with the Insurer Company in the interest of the employees. As per the scheme, premiums were also deducted from the salary of the deceased employee.

On 20.04.2008, while the deceased employee was on duty in the workshop in the second shift and was doing his work, he fell down and become injured. Consequently, with the help of the co-workers he was sent to the local hospital and thereafter to the Central Hospital, Naisarai. He remained in the said hospital till 03.5.2008 when he was discharged.

However, it is alleged that since the husband of the petitioner retired on 30.4.2008; as such he was forcibly relieved from the hospital on 03.5.2008. Thereafter, he went to his residence. However, when his condition deteriorated he was again admitted to Nidan Nursing Home, Lohsingha, Hazaribagh where the deceased employee died during the treatment on 13.5.2008. FIR was also registered with the local police station under section 304-A of the IPC.

4. Mr. Yogendra Prasad, learned counsel for the petitioners submits that the premiums were duly deducted from the salary of the deceased employee and as such the petitioners are duly entitled for the claim amount of Rs.5,00,000/-being the sum assured as the deceased employee died as a result of the injury which he sustained while in service.

He further submits that since the deceased employee retired from service on 30.04.2008; he was discharged from the company hospital on 03.05.2008. However, when his condition deteriorated, the deceased employee got admitted in a private hospital and at the time of operation he died on 13.5.2008.

Learned counsel further submits that F.I.R. was also lodged before the local police station. Pursuant to the death of the deceased employee, the original-petitioner made a claim for the benefits which was due on account of death of her husband as he died due to an accident while on duty as per the insurance policy and MOU entered between the employer and Insurance Company. However, for the reasons best known to the respondents; no amount was paid to the original-petitioner or to the legal heirs who are the present petitioners.

Learned counsel for the petitioners further submits that the stand of the respondents that the claim reached the insurance company beyond 90 days is non-est in the eye of law, inasmuch as, this court in various decisions has held that delay in submission of claim application would not be a hurdle in payment of the claim amount to the beneficiaries; as such, the respondents be directed to pay the insurance claim amount to the legal heirs of the deceased employee who are the present petitioners.

In support of his contention learned counsel relied upon the judgment passed in the case of Ajay Kumar Nonia Versus C.C.L. & Ors. [W.P.(S) 37 of 2013] and also in the case of C.C.L. vs. O.I.C.L. & Smt. Yashoda Devi (L.P.A. No. 347 of 2013).

5. Mr. A.K. Das, learned counsel for the respondent C.C.L. relying upon its counter affidavit submits that the documents in support of claim for insured amount was received on 27.8.2008 and the same was duly forwarded to the Oriental Insurance Company-Respondent No.5 on 30.8.2008. However, Respondent No.5 regretted the claim